Hey doc. Another knee one for ya. Except I'm not sure if it's the knee's fault.

This fall I began having knee pain. I searched your old posts and found a lot of good info. I checked everything out. I realized that my new seat I had installed sat too far forward. So I fixed it.

My knee had only hurt when on the road bike and felt fine on the mtb. So I figured it had to do with the road setup. I think I've tried everything. Even staying off the road bike for a few weeks. What I did notice was that when my knee started feeling pain my upper hamstring also felt pain. Once when both regions began feeling discomfort I used my fingers and pressed on the my hamstring at the spot where my leg connects to my ass. that caused more discomort. It also increased the pain in my knee.

Recently I've taken a break from training to sit on my ass and eat crap for a few weeks. I started going to the gym regularly. I did my first leg workout on monday. My knee was feeling fine. I got invited for a short MTB ride tuesday and my knee flared up as well as my hamstring.

Now for the last two days my hamstring feels a bit strained and my knee aches.

I am back on line, thanks for your patience in waiting for a reply. The symptoms you are describing are consistent with a tendonitis where your hamstring inserts into the pelvic bone. There may also be a component of ileo-tibial band syndrome. Do some stretching exercises (get Bob Anderson's excellent book Stretching. Also look at your road bike seatpost height as it may be too high. If you are rocking at the hips to reach bottom dead center (BDC) or your knee nearly locks at BDC of your pedal stroke lower your seat height 1/2 to 1 centimeter at a time and try the new position. You should have about a 10-15 degree bend in your knee when at BDC. For your mountain bike for off road riding use a slightly lower saddle height, with a knee bend of about 20 degrees at BDC. Also set the seat height based on your pedalling style. If you pedal with you heal down at bottom dead center, you will need to set you height slightly lower than if you would with your feet parallel to the ground at BDC. However, if you tend to pedal toes down at BDC you will actually set you seat height slighly higher than that with foot level at BDC. If your symptoms worsen or persist, see your physician and possibly a physical therapist for further evaluation and treatment.

I think I may have found the culprit. I was continuing to have this problem even after taking 3 weeks off the bike.

Stretching my legs really well before riding seemed to help somewhat, but only for 30 minutes or so.

Thanks to merrittacupuncture.com for suggesting that could be the problem.

I had always wanted to try out actupuncture for fun so I went. She asked a ton of questions. When I was describing this and mentioned I was starting to think one leg might be shorter than the other she thought one side of my lower back might be tighter than the other. During the massage part of the visit she found that indeed one side was tighter than the other.

So last week I was doing a road ride. Pain came so I stopped and strectched my legs. Pain went away for a lil bit, but came back. I then stopped and strectched my lower back and sides BLAM! I was fixed! Next few hours were pain free.

Thanks for the follow up. We were on the right track with stretching. Check your saddle and handle bar stem length. If you are too stretched out with a saddle that is too far back or a stem that is too long, you may experience back muscles spasms. For checking your saddle fore-aft position, get the help of a friend and a wall or pole. Clip in your pedals or position your foot with the ball centered over the pedal axel while you are leaning on the wall or pole. Position your pedals dead horisontal, parallel to the ground. With the help of your friend drop a plum line from the boney knot just below the knee cap, called the tibial tuberosity, on the forward leg at the 9 o-clock position. The plumb line should intersect the axel when the saddle is in the correct fore aft position while you are seated comfortably in the middle of the saddle. You can adjust forward or backward several millmeters to find your sweet spot to minimize back muscle spasms and maximize power transfer to the pedal.

For the bar stem length, with your hands on the grips and your elbow bent and leaning forward about 45 degrees you should be able to look down over the handle bars and the front wheel axel should be obscured by the handle bars. If the axel is behind the handle bars you may need to switch to a slightly shorter bar stem. Also look at handle bar hight. If it is too low that also can trigger back muscle spasms. A hight that works for a yonger limber rider seen on the cover of Mountain Bike Action may not work for us mere mortals, so don't be affraid to try a higher handlebar position to accomadate your less limber spine.

Just a couple of notes on bike fit. The Doc is right about dropping a plumb line but you should mount your bike on a trainer and level the front wheel, then pedal for a few minutes before dropping the plumb line. A rider will shift back and forth on the saddle while warming up so be sure and check the knee position after you have settled into your natural position. Remember that if you raise the saddle, you also shift it backwards and dropping it moves it forwards so allow for that.

Looking at the relative position of the handlebars to the front axle is a good rough measurement of a bike and is used regularly to find a frame that can be fitted to a rider. Since you will have the bike in the trainer and you are warm anyway, stop the pedals at a 45 degree angle (at 10:30 and 4:30). With your hands in the drops, bend your elbow at 30 degrees and measure the distance between your elbow and your knee. It should be 1 to 1.5 CM. This measurement will allow for people who's limbs are short or long. It will also insure you do not hit your elbow against your knee when you are hammering.

A proper fit from someone who knows how is worth 100 pounds of ibuprophin!

Have you started running or doing any other type of impact / cross training. I've noticed that if I start running, as a compliment of fitness to my cycling, I'll develop some knee and or hip related pains that become chronic. When I do start running a little I'll start very, very slow, run on the track with a forgiving surface and stretch till I feel like gumby.

Have you changed your seat (not position)? Or, have you been training on a spin bike at the gym? The spin bikes are definitely not a good fit for a cyclist of your caliber. You've very tuned legs and the spin bike if riden hard can definitely cause problems. The spin bikes at pure austin don't fit my booty correctly and cause sharp pains in my hips. The spin bikes at Lifetime Fitness work fine for me (I belong to both clubs-no endorsement).

Also, do you notice one leg being weaker than the other? When this happens (most cyclist have this problem) there tends to be compensation by the stronger leg. Then if you develop an injury in the weaker leg the stronger leg works harder and a similar injury can occur. A lot of top cyclist will do one legged spins of up to a 1000+ rotations to develop a more unified pedal stroke and balance the muscle development of each leg.

I'd keep track of any changes in your training outside the bike. There is a tendency to look at bike fit (very important) first, but small changes in training can definitely affect a well tuned rider.

The pain mostly went away after stopping all activity, but I've aways had discomfort in my lower back. In highschool I took up swimming. That didn't bother my back too much. I've never been able to run or do sports such as basketball. Those activities always aggrevated it. Luckily cycling has been pretty much ok with my back. The past couple months it is flaring up more so. Maybe due to a new bed purchased earlier this year?- being that every morning at 4am I wake up in pain. 3-5 on a scale of 10. Maybe a $1200 mattress isn't all it's cracked up to be? Been to the neurologist and he confirmed a recent mri showed stress fractures and a lil disk bulging.

The previous link hints at hamstring tightness. The following article links them together. Even tho I don't play tennis I think I fit the bill dead on. Sucks, but at least I know what's going on and my chronic hamstring pain while riding is explained. Possibly even my knee pain. Doesn't help I crashed on that knee last month.

Stretching exercises as outlined in the excellent book "Stretching" by Bob Anderson is a good start. You want to keep the leg and back muscles and tendons limber and daily stretching can help reduce the occurrence of tendonitis and muscle strains/spasms.

Risk of a local shot in the lumbar region are low but do include local pain, pain radiating down the nerve if it is inadvertently struck, infection, local tissue necrosis and local numbness. In the hands of an expert who does these injections frequently, these risks are extremely low. The benefits are that there can be temporarily relief of the pain which in turn will allow you to stretch and gently exercise the muscles and tendons.

Another thing to consider in regard to your bone strength is having your bones evaluated for low density (osteopenia) or marked thinning and weakening (osteoporosis) bicycle riders are prone to these problems even at the young age of 30. Mountain bike riders are less prone to have these problems. If you log-in name is any description of your body habitus (XL) you are not as likely to be prone to these problems. It is a curse of the sveltes. If, however, you just happen to like XL Cheese pizzas and are built on the lean cuisine side, then an evaluation of your bone density is in order. If you are found to have low bone density then there are medications and supplements that can be taken that can help increase your bone density.

Visit with your doctor on these maters, discuss your questions and be satisfied with the information you receive so you can make an informed decision regarding your therapy options.